CN102133138B

CN102133138B - Knee prosthesis system

Info

Publication number: CN102133138B
Application number: CN201110031384.XA
Authority: CN
Inventors: D·D·奥格尔; D·P·费茨佩特里克; J·G·威斯; A·P·赖特; C·M·沃纳; S·A·黑兹布劳克; D·L·德芬鲍夫
Original assignee: DePuy Products Inc
Current assignee: DePuy Ireland ULC
Priority date: 2010-01-21
Filing date: 2011-01-21
Publication date: 2016-04-27
Anticipated expiration: 2031-01-21
Also published as: JP2011147779A; CN105640672A; EP2901970A1; US20110178605A1; AU2011200228A1; EP2347733A1; CN102133138A; US9011547B2; EP2347733B1; AU2011200228B2; CN105640672B; JP5819068B2; ES2564105T3; EP2901970B1

Abstract

The invention discloses a kind of knee prosthesis system for total knee replacement, it comprises the visibly different femoral component of sizes, sizes visibly different fixed tibial parts, the visibly different movable tibial component of sizes, multiple fixing insert and multiple removable inserts.The size and dimension of each described removable inserts is defined as making it to mate best with one of described femoral component, and can use together with any one in described movable tibial component.The size and dimension of each described fixing insert is defined as making it to mate best with one of described femoral component, and can use together with any one in described fixed tibial parts.

Description

Knee prosthesis system

Background technology

The disclosure relates generally to surgery device and operation, more particularly, relates to implantable Total knee arthroplasty prosthese.

Comprised three parts by the knee prostheses of the most widely used type in Total knee arthroplasty (TKR) operation in patients with implantation body: metallic femoral component, it is attached to distal femur; Metal tibial component (or pallet), it is attached to proximal tibia; And polymer (UHMWPE) insert (also claiming supporting member or insert), it is installed between femoral component and tibial component.Also can obtain some the various types of Patellar arthoplasty things be combined with these knee prostheses.Two types of knee prostheses are: for posterior stabilized (PS) prosthese that uses when posterior cruciate ligament no longer includes vigor and (afterwards) ligamentaum cruciatum conservative (CR) knee prostheses.Each be set to fixed bearing knee prostheses of the knee prostheses of this two type, wherein insert is not relative to tibial component motion, or is set to expansion bearing knee prostheses, and wherein insert rotates on the smooth platform of tibial component.Use removable inserts still to fix insert and depend on the knee joint ligament of patient and the situation of other soft tissue to a great extent.

Knee prosthesis system can comprise the femur of sizes, tibia and insert parts, to adapt to the difference of patient anatomy in whole world TKR PATIENT POPULATION.The design of knee prosthesis system needs to weigh between many key factors, described factor relates to (only exemplifying) exercise performance, clinical effectiveness, implant durability, cost and ease for use.Important consideration about both the exercise performance of knee prostheses and life-span is that the type between femoral component area supported and insert area supported is right.

Research worker is usually by coronalplane or the right crowning radius being characterized by the condyle of femur of femoral component of the sagittal type ratio with the concave on the insert surface connected.Type conjunction rate is zero represent smooth insert surface, corresponding to the very high contact stress under high capacity.Type conjunction rate is that 0.99 to represent high type right, usually correspond to high contact area, relatively low contact stress, and the wear rate of thing followed insert polyethylene surface reduces.

Research worker has been found that the right impact on the prosthese life-span of the type of coronalplane may be greater than the right impact on the prosthese life-span of sagittal type.Such as, the people such as Kuster paper " Theeffectsofconformityandloadintotalkneereplacement (impact in the medium-sized right and load of Total knee arthroplasty) " ( clinicalOrthopaedicsandRelatedResearch (clinical plastic surgery and phase close research), the 375th phase, 302-12 page, in June, 2000) in, author finds that compressive surface stresses, shear stress and vonMises stress are subject to the impact of type conjunction rate change, and less by the impact of load change.The people such as Berend more recently paper " EffectsofcoronalplaneconformityontibialloadinginTKA:acom parisonofAGCflatversusconformingarticulations (in TKR the smooth comparison of to close joint with type and being connected of the right impact on tibia load of coronalplane type: AGC) " ( surgicalTechnologyInt. (surgery operating technology), the 18th phase, 207-212 page, 2009) in, the author investigation impact of the right proximal tibia load on patient of type.Inappropriate load of proximal tibia can cause the aseptic loosening of tibial component in tibia, and finally causes prosthese lost efficacy thus needed prosthesis.Author finds that hat causes the anterointernal strain of tibia to increase to spill distortion parts, causes the strain on rear side of tibia significantly to reduce simultaneously.They also find type close be connected with smooth joint in proximal tibia strain and reduce and concentrate.

But, knownly in this area be, the right bad load state that also can cause (such as) insert surface of very high type, or cause the Over-constrained to femoral component, thus inhibit the joint motions wanted of overstating for joint performance and patient comfort degree.Therefore, as long as stress is lower than the yield strength of insert material, then it can be best for designing with the intermediate value of contact area, to reach the best of breed of arthrochalasis and type conjunction rate.

The patient anatomy of global TKR PATIENT POPULATION is different, and this makes the challenge faced by knee prostheses designer complicated.There is the knee prostheses that the less patient's significant need of the build of less femur is less.Compared with the large femoral component for the large patient of build, in the femoral component of little femoral component, ectocondyle has less crown radius separately.In order to keep suitable type conjunction rate and comprise other geometrical relationship of condyle spacing, little femoral component must mate with the insert of suitable dimension.But except large-scale patient size, the dimension scale between femur and tibia also alters a great deal.Such as, for the proximal tibia of intended size, some patients have the distal femur larger than other patient.In this case, when using knee prosthesis system available at present, the femoral component that doctor may need to select implantation not mate a little with femur and mate with insert, or mate and femoral component unmatched a little with insert with femur.

Therefore, according to above-mentioned consideration, need so a kind of knee prosthesis system, it allows doctor to select the femoral component conformed to the femoral size of particular patient, the tibial component conformed to tibial bone dimensions and with femoral component optimum matching and the insert compatible with tibial component.This knee prosthesis system should comprise both prostheses of fixed type and Activity Type, and for CR and PS these two kinds operations.In addition, described system should take the various changes of the patient anatomy of whole world PATIENT POPULATION into account.

Except the knee prostheses parts that optimum matching is provided, also exist and keep and reduce the cost of knee prosthesis system and the lasting needs of complexity.Knee prosthesis system can comprise sizes, respectively for the femoral component of left and right knee joint, tibial component and insert, to adapt to the change of patient anatomy and situation.In addition, each insert can have multi-thickness, thus doctor can select the one causing suitable joint tension force.Therefore, knee prostheses manufacturer must provide the very large parts stock representing the combination of a large amount of different size, to take worldwide PATIENT POPULATION into account.Therefore, need the knee prosthesis system allowing the interchangeable improvement of parts, to obtain necessary dimension combination with minimum parts.

Another consideration in knee prosthesis system design process is the bone preparation of implanting for PS femoral component.Both PS and CR femoral components all have the condyle of pair of separated, and described condyle is similar to a certain extent to the natural condyle of distal femur.For PS femoral component, the box (or intercondylar fossa) between condyle comprises feature interactional with the spinous process on PS insert.The implantation of PS femoral component needs at distal femur cut-in groove to receive described box.In the knee prosthesis system that some are current, for all PS femoral component sizes, the size of box is all identical, thus needs the groove at distal femur cutting same size, even if be also the same for less femur.But, if possible, preferably between the warming up period of the femur in order to attached femoral component, preserve natural skeleton.Therefore, also need so a kind of knee prosthesis system, they are while the aforementioned needs of solution, and each PS femoral component has the box that its size is determined in proportion relative to femoral size.

Another consideration in knee prosthesis system design process is the bone preparation for tibial component implants and carry out.Current obtainable activity and fixing TKR prosthesis system comprise the tibial component of the anatomic dimensions in certain limit.For some in these systems, the tibial component for the movable TKR prosthese of specific dimensions has the structure different from the structure of the fixing TKR prosthese of same size.Specifically, support that the shape of the platform of fixed bearing insert can be different from the shape of the platform of support activities support insert.This can cause the coverage of the tibial plateau surfaces excised that little (but may be significant) difference occurs.Although desirable not to the utmost, the tibia coverage of doctor by selecting the tibial component of large-size to obtain expectation.More preferably, be provided with TKR system that is movable and fixed tibial parts and there is the general-purpose platform contour shape optimized for the interaction, exercise performance etc. with surrounding tissue.

In addition, current obtainable TKR system is provided with such tibial component, and its shank with variable-length is to adapt to different tibia situation.In addition, the structure of movable tibial component shank can be different from the structure of fixed tibial member shank.Then, this kind of system requirements has reaming tools different in a large number for each surgical operation.Preferred TKR system can comprise the activity and fixed tibial parts with different length shank, but does not require several the different reaming tools for preparing tibia.This also provides flexibility ratio in the art of the tibial component selecting suitable type for doctor, reduces simultaneously and need number of instruments for subsequent use in surgical operation.

Accompanying drawing explanation

Although this description is summarized with claims, wherein particularly point out and clearly advocate right of the present invention, the following description and accompanying drawing will further illustrate claimed limiting examples more of the present invention.Except as otherwise noted, identical Reference numeral refers to identical key element.

Fig. 1 is the perspective view of fixation of C R prosthese 110.

Fig. 2 is the perspective view of CR femoral component 20, and described CR femoral component is a part for the fixation of C R prosthese 110 shown in Fig. 1 and the mobile C R prosthese 130 shown in Fig. 9.

Fig. 3 is the perspective view of fixation of C R insert 50, and described fixation of C R insert is a part for the fixation of C R prosthese 110 shown in Fig. 1.

Fig. 4 is the perspective view of fixed tibial parts 70, and described fixed tibial parts are parts of the fixing PS prosthese 120 shown in the fixation of C R prosthese 110 shown in Fig. 1 and Fig. 5.

Fig. 5 is the perspective view of fixing PS prosthese 120.

Fig. 6 is the perspective view of PS femoral component 10, and described PS femoral component is a part for the movable PS prosthese 140 shown in the fixing PS prosthese 120 shown in Fig. 5 and Figure 13.

Fig. 7 is the perspective view of fixing PS insert 30, and described fixing PS insert is a part for the fixing PS prosthese 120 shown in Fig. 5.

Fig. 8 is the perspective view of fixed tibial parts 70, and described fixed tibial parts are also shown in Figure 4.

Fig. 9 is the perspective view of mobile C R prosthese 130.

Figure 10 is CR femoral component 20 is perspective views, and described CR femoral component is also shown in Figure 2.

Figure 11 is the perspective view of mobile C R insert 60, and described mobile C R insert is a part for the mobile C R prosthese 130 shown in Fig. 9.

Figure 12 is the perspective view of movable tibial component 80, and described movable tibial component is a part for the mobile C R prosthese 130 shown in Figure 13 and movable PS prosthese 140.

Figure 13 is the perspective view of movable PS prosthese 140.

Figure 14 is the perspective view of PS femoral component 10, and described PS femoral component is also shown in Figure 10.

Figure 15 is the perspective view of movable PS insert 40, and described movable PS insert is a part for the movable PS prosthese 140 shown in Figure 13.

Figure 16 is the perspective view of movable tibial component 80, and described movable tibial component is also shown in Figure 12.

Figure 17 represents the chart combining the knee prosthesis system 100 be configured by sizes, and each prosthese is shown in Fig. 1,5,9 and 13.

Figure 18 is the front view of the movable tibial component of size 1.

Figure 19 is the front view of the movable tibial component of size 3.

Figure 20 is the front view of the movable tibial component of size 7.

Figure 21 is the front view of the movable tibial component of size 9.

Figure 22 A is the top view of the movable tibial component of the size one of Figure 18.

Figure 22 B is the top view of the fixed tibial parts of size 1.

Figure 23 A is the top view of the movable tibial component of the size 3 of Figure 19.

Figure 23 B is the top view of the fixed tibial parts of size 3.

Figure 24 A is the top view of the movable tibial component of the size 7 of Figure 20.

Figure 24 B is the top view of the fixed tibial parts of size 7.

Figure 25 A is the top view of the movable tibial component of the size 9 of Figure 21.

Figure 25 B is the top view of the fixed tibial parts of size 9.

Detailed description of the invention

In the disclosure, term " forward and backward, outer, interior " usually refers to forward and backward, outside and the center line of surgery patients respectively, although also use these terms for device in literary composition.Fig. 1 shows the directional arrow for these terms and term " upper and lower ".In addition, we have anyone that be intended to be also included within surgical operation when mentioning " doctor " and " user " and can help doctor.

Following entirety is incorporated herein by reference.

United States Patent (USP) 7,628,818, title is " Fixed-BearingKneeProsthesisHavingInterchangeableComponen ts (having the fixed bearing knee prostheses of interchangeable part) ", within 28th, submitted in JIUYUE in 2007 by the people such as Hazebrouck (hereinafter referred to as " Hazebrouck " "), and announce on April 2nd, 2009.

U.S. Patent application No.12/165582, title is " Posterior-StabilizedOrthopaedicProsthesis (posterior stabilized orthopedic technical aid) ", is submitted on June 30th, 2008 by the people such as Wyss (hereinafter referred to as " Wyss ").

Hazebrouck discloses fixed bearing knee prosthesis system, wherein the insert of different size separately can be compatible with the tibial component of often kind of size, makes doctor can select the tibial component that its size is suitably determined for patient's tibia and the insert mated with femoral component.

Wyss discloses so a kind of knee prosthesis system, and described knee prosthesis system has the visibly different PS of sizes (fixed or movable) insert, and described insert has the spinous process upwards extended from lower surface.The rear side of described spinous process has depression cam face and actuating cam face.Each PS femoral component has a pair isolated condyle, and described condyle limits the intercondylar fossa with rear cam.Rear cam comprises depression cam face and actuating cam face.In the flexing process of first stage, the actuating cam face of the depression cam face kissing spines of rear cam, in the flexing process of second stage, the depression cam face of the actuating cam face kissing spines of rear cam.

Fig. 1-16 shows each parts of knee prosthesis system 100 shown in Figure 17.Each in these parts all can have sizes, and can match together as described below, thus provides a large amount of dimension combination for doctor.By utilizing knee prosthesis system 100, doctor can select the dimension combination of both the femur and tibia correctly mating patient for each patient in large PATIENT POPULATION.That is, the size of femoral component is determined obviously different to coordinate femur, and the size of tibial component is determined obviously different to coordinate tibia, and the parts of knee prostheses are mated to avoid to take compromise to joint performance best.

The visibly different femur of size of knee prosthesis system 100 and a feature of tibial component are each parts will be connected the skeleton of specific dimensions thereon proportionalities with described parts.Usually, the dimension scale of parts changes, but shape invariance.Such as, femoral component can have the intercondylar distance that size is determined in proportion, makes the intercondylar distance of large femoral component be greater than the intercondylar distance of little femoral component pari passu.Similarly, large tibial component can have rear breach wider and darker in ratio compared with little tibial component.

Fig. 1 is the perspective view of ligamentaum cruciatum conservative fixed bearing knee prostheses 110, it is also referred to as fixation of C R prosthese 110, and it comprises CR femoral component 20 (Figure 10), fixation of C R insert 50 (Figure 11) and fixed tibial parts 70 (Figure 12).Fixation of C R prosthese 110 can be same or similar with the knee prostheses of Hazebrouck shown in Figure 1.Hazebrouck discloses any one in the visibly different tibial component of any one be fixed to sizes (or pallet) in the visibly different insert of sizes (or supporting member).Therefore, geometry and the further feature of the articulation surface of insert can be improved for the size of each femoral component.This exchange ability also allows less to increase size when designing a series of femoral component.CR femoral component 20 comprises interior condyle 24 and ectocondyle 26, and both upper surface 56 upper joint at fixation of C R supporting member 50 connects.CR insert 50 remains on fixed tibial parts 70 by the front buttress (buttress) 75 of fixed tibial parts 70 and rear buttress 76 regularly, and the lower surface 54 of CR insert 50 is placed on the platform 72 of fixed tibial parts 70.Fixed tibial parts 70 also comprise the shank 74 be inserted into by the proximal tibia of surgical operation preparation.

Fig. 5 is posterior stabilized fixed bearing knee prostheses 120, and it also claims fixing PS prosthese 120, and it comprises PS femoral component 10, fixing PS insert 30 and fixed tibial parts 70.PS femoral component 10 can be same or similar with the femoral component of Wyss shown in Figure 1.PS femoral component 10 comprises interior condyle 14 and ectocondyle 16, and both upper surface 36 upper joint at fixing PS insert 30 connects.PS femoral component 10 also comprises the box 32 between condyle 14 and ectocondyle 16.Box 32 encases the rear cam and front cam (the two is all invisible) that operationally engage with the spinous process 32 of fixing PS insert 30, as described in Wyss.Front buttress 75 and the rear buttress 776 of fixed tibial parts 70 can keep PS insert 30, and the lower surface 34 of PS insert 30 is seated on the platform 72 of fixed tibial parts 70.

Fig. 9 is the perspective view of ligamentaum cruciatum conservative expansion bearing knee prostheses 130, and it also claims mobile C R prosthese 130, and it comprises CR femoral component 20 (being described with reference to Fig. 2), mobile C R support insert 60 and movable tibial component 80 above.The interior condyle 24 of CR femoral component 20 is connected with upper surface 66 upper joint of ectocondyle 26 at mobile C R insert 60.The lower surface 64 of mobile C R insert 60 connects relative to platform 82 joint of movable tibial component 80.The hollow handles 84 of post 68 from lower surface 64 to downward-extension and rotatably insertion activity tibial component 80.

Figure 13 is posterior stabilized expansion bearing knee prostheses 140, it is the movable PS prosthese 140 of title also, and it comprises PS femoral component 10 (being described with reference to Fig. 6), movable PS insert 40 and movable tibial component 80 (being described with reference to Figure 12) above above.Movable PS insert 40 comprises upper surface 46 and spinous process 42 that can be identical with spinous process 32 with the upper surface 36 of the fixing PS insert 30 shown in Fig. 7.Movable PS insert 40 also comprises lower surface 34 that can be identical with the lower surface 54 of the fixation of C R insert 50 shown in Fig. 3.

Figure 17 is the chart of the integral type knee prosthesis system 40 representing each knee prostheses comprised in Fig. 1, Fig. 5, Fig. 9 and Figure 13.Each parts 10,20,30,40,50,60,70 and 80 can be arranged according to sizes (such as, ten kinds of sizes), to adapt to the anatomical structure of PATIENT POPULATION's wide variation.These parts can match together as follows:

Arbitrary size of PS femoral component 10 can be mated with arbitrary size of fixing PS insert 30 or removable inserts 40.

Arbitrary size of CR femoral component 20 can be mated with arbitrary size of fixation of C R insert 50 or mobile C R insert 60.

Arbitrary size of fixed tibial parts 70 can be mated with arbitrary size of fixing PS insert 30 or fixation of C R insert 50.

Arbitrary size of movable tibial component 80 can be mated with arbitrary size of movable PS insert 40 or mobile C R insert 60.

In addition, often kind of size of each insert 30,40,50 and 60 can provide by multi-thickness.

As previously mentioned, the anatomical structure of patient not only changes in size, and changes in the dimension scale of femur/tibia.Utilize the historical data that TKR performs the operation, the dimension combination needed for the intragroup Most patients in the whole world can be defined as.Such as, the knee prostheses that useful size is determined obviously different adapts to the cooperation for both the femur and tibia of each patient in similar all patients, and implementation is as follows: by being matched by the tibial component in femoral component and large two kinds of sizes or little two kinds of size ranges.The CR femoral component of " size 3 " can use together with any one in (fixed or movable) tibial component of " size 1,2,3,4 or 5 ", and the CR femoral component of " size 1 " can use together with any one in (fixed or movable) tibial component of " size 1,2 or 3 ".Similarly, the fixed tibial parts of " size 5 " can use together with any one in the fixing insert of (CR or PS) of " size 3,4,5,6 or 7 ".By utilizing knee prosthesis system 100, the every femoral component that enables for a pair in these pairings mates with insert, best to keep desirable geometrical relationship.

Table 1 lists the parts of the knee prosthesis system 100 of exemplary embodiment.Table 2 lists the femoral component size that each femoral component of listing for table 1 provides.Table 2 also provides for each femoral component size: for the insert size that each insert listed in table 1 is compatible, and for the compatible tibial component size of each tibial component listed in table 1.

table 1: knee prosthesis system parts

Parts	The number of size	The number of thickness	The number of parts
				PS femur (right side)	14	---	14
PS femur (left side)	14	---	14
				CR femur (right side)	14	---	14
CR femur (left side)	14	---	14
				Movable PS insert	10	9	90
Fixing PS insert	10	9	90
				Mobile C R insert	10	8	80
Fixation of C R insert	10	8	80
				Movable tibia	10	---	10
Fixed tibial	10	---	10
				Amount to			416

table 2: compatible size

Femoral component size	Insert size	Tibial component size
			1	1	1，2，3
2	2	1，2，3，4
			3	3	1，2，3，4，5
3N	3	1，2，3，4，5
			4	4	2，3，4，5，6
4N	4	2，3，4，5，6
			5	5	3，4，5，6，7
5N	5	3，4，5，6，7
			6	6	4，5，6，7，8
6N	6	4，5，6，7，8
			7	7	5，6，7，8，9
8	8	6，7，8，9，10
			9	9	7，8，9，10
10	10	8，9，10

The embodiment of table 1 and the knee prosthesis system shown in table 2 100 provides 2176 kinds of unique prosthetic component combinations.These combinations each in, the size of femoral component determine obviously different to coordinate the femur of patient, simultaneously with insert optimum matching, and the size of tibial component determined obviously difference to coordinate the tibia of patient, while compatible with insert.As a result, knee prosthesis system 100 can allow doctor need not compromise between exercise performance and implantation joint life-span to each patient in world PATIENT POPULATION.

As pointed out above, patellar component also can provide for implantation with knee prostheses in combination.Patellar component can be provided sizes.Be suitable for the example of the patella implant be used in knee prosthesis system 100 for DePuyOrthopaedics can be derived from, " the P.F.C.Sigma patella implant " of Inc. (Warsaw, IN).Another embodiment of knee prosthesis system 100 also can comprise the patellar component of two kinds of unique types, and each type has five kinds of sizes, thus allows doctor from 21, selects in 760 kinds of unique unit constructions.These combinations each in, the size of femoral component determine obviously different from mate the femur of patient, simultaneously with insert optimum matching, and the size of tibial component determined obviously difference to coordinate the tibia of patient, while compatible with insert.

Knee prosthesis system 100 allows doctor to select a kind of combination for implantation into the knee prostheses parts in patient body, the size of wherein said parts is determined obviously different to coordinate femur and the tibia of patient, simultaneously also by optimum matching, take compromise to avoid the performance to rebuilding joint.Knee prosthesis system 100 also provides PS femoral component, since (fixed or movable) PS insert mates with each PS femoral component, the size of described PS femoral component is just defined as applicable femur in proportion.Knee prosthesis system 100 also can reduce cost and the complexity of required implantation parts stock, and to take worldwide PATIENT POPULATION into account, this is mainly due to the interchangeability of parts.

As illustrated, need so a kind of knee prosthesis system above, it comprises activity and the fixed tibial parts of the shank with different length, but does not require several the different reaming tools for preparing tibia.As shown in figure 17, movable tibial component 80 and fixed tibial parts 70 can have roughly similar or identical outside dimension for often kind of anatomic dimensions and structure, make doctor that identical apparatus can be utilized according to roughly the same mode preparation proximal tibia.This also allows doctor after getting proximal tibia ready in advance by surgical operation, even implant the tibial component of any one type.

Figure 18,19,20 and 21 shows the movable tibial component 80 of four kinds of representative dimensions of knee prosthesis system 100.Such as, knee prosthesis system 100 can have the fixed tibial parts 70 of ten kinds of sizes and the movable tibial component 80 of ten kind of size, as shown in table 2.Figure 18 is the front view of the movable tibial component 150 of size 1, its a pair opposed Os Draconis 151,153 having the platform 152 of size 1, the shank 154 of size 1 and extend between shank 154 and platform 152.Shank 154 have length for the distal portions 156 of " E " and length be the proximal part 158 of " A ".

Figure 19 is the front view of the movable tibial component 160 of size 3, and it has the platform 162 of size 3, the shank 164 of size 3 and a pair opposed Os Draconis 161,163.Shank 164 has length and is similarly the proximal part 168 that the distal portions 166 of " E " and length are " B ".

Figure 20 is the front view of the movable tibial component 170 of size 7, and it has the platform 172 of size 7, the shank 174 of size 7 and a pair opposed Os Draconis 171,173.Shank 174 has length and is similarly the proximal part 178 that the distal portions 176 of " E " and length are " C ".

Figure 21 is the front view of the movable tibial component 180 of size 9, and it has the platform 182 of size 9, the shank 184 of size 9 and a pair opposed Os Draconis 181,182.Shank 184 has length and is similarly the proximal part 188 that the distal portions 186 of " E " and length are " D ".

As Figure 18,19, shown in 20 and 21, length " D " is greater than length " C ", and length " C " is greater than length " B ", and length " B " is greater than length " A ".Usually, the shank length of increase corresponds to the increase length of shank proximal part, and the length of distal portions remains unchanged.

Distal portions 156,166,176 and 186 also can have the shape of identical general conical.Proximal part 158,168,178 and 188 can have roughly the same frusto-conical shape, and mainly changes in length.Os Draconis 151,153,161,163,171,173,181,183 can have roughly similar structure and orientation.It will be apparent to those skilled in the art that doctor can use identical reaming tool to come to be formed at proximal tibia the chamber of desired depth, to receive any one in the shank 154,164,174 and 184 of various sizes.Because external dimensions each in sizes visibly different fixed tibial parts and structure can be corresponding with the visibly different movable tibial component of described sizes roughly similar or identical, so for intended size arbitrary described fixed or movable tibial component the surgical operation preparation of proximal tibia can be identical, and for all sizes of both fixed and movable tibial components, the apparatus of needs can be identical.

As illustrated above, also wish that Total knee arthroplasty system comprises the activity and fixed tibial parts with general platform contours or " occupied area ", described platform contours or " occupied area " are optimized for the coverage of tibial plateau, reciprocal action, exercise performance and the other factors with surrounding tissue.What Figure 22 A, 22B, 23A, 23B, 24A, 24B, 25A and 25B showed the fixed and movable tibial component of four kinds of representative dimensions of knee prosthesis system 100 overlooks (plane) figure.As previously mentioned, knee prostheses parts 100 can have the fixed tibial parts 70 of ten kinds of sizes and the movable tibial component 80 of ten kind of size, as shown in table 2.

Figure 22 A shows the movable tibial component 150 of size 1, and it has the platform 152 with " occupied area " of the platform 252 of the fixed tibial parts 250 of the size 1 shown in Figure 22 B or " occupied area " of profile similarity or profile.

Figure 23 A shows the movable tibial component 160 of size 3, and it has the platform 162 with the profile of the profile similarity of the platform 262 of the fixed tibial parts 260 of the size 1 shown in Figure 23 B.

Figure 24 A shows the movable tibial component 170 of size 7, and it has the platform 172 with the profile of the profile similarity of the platform 272 of the fixed tibial parts 270 of the size 1 shown in Figure 24 B.

Figure 25 A shows the movable tibial component 180 of size 9, and it has the platform 182 with the profile of the profile similarity of the platform 282 of the fixed tibial parts 280 of the size 1 shown in Figure 25 B.

For the tibial component of often kind of size, for both activity and fixed tibial parts for specific anatomical size, platform contours (from top along the direction of shank axis) is identical.When selecting between activity and fixed fae body, do not need to change tibial component size to obtain identical tibial plateau coverage.Another advantage of general-purpose platform shape is the part that can use identical molder's tools or described instrument in the manufacture process of two kinds of tibial components, and component costs is reduced.

More than illustrate and describe various embodiment and example.But those of ordinary skill in the art can revise method and apparatus described herein and not depart from general conception of the present invention.Such as, the concrete material of accompanying drawing, size and ratio are appreciated that limiting examples.Therefore, the scope of following claim should not to be understood to be limited in description and accompanying drawing the details of display and the structure described, material or behavior.

Claims

1., for the knee prosthesis system of ligamentaum cruciatum conservative (CR) and posterior stabilized (PS) total knee replacement, it comprises:

A. many fixation of C R knee prostheses;

B. many mobile C R knee prostheses;

C. many fixing PS knee prostheses; And

D. many movable PS knee prostheses;

Wherein each prosthese represent a kind of set of dimensions merge comprise one of one of multiple femoral component, multiple tibial component and one of multiple insert, and each prosthese mates best in order to performance, and there is visibly different size to coordinate the anatomical structure of patient, thus described knee prosthesis system can be used for the various anatomical structures in PATIENT POPULATION, often kind of size of each prosthese provides with multi-thickness, list the parts of knee prosthesis system with following table 1, and list with following table 2 the femoral component size that each femoral component of listing for table 1 provides:

table 1: knee prosthesis system parts

table 2: compatible size

Femoral component size Insert size Tibial component size 1 1 1, 2, 3 2 2 1, 2, 3, 4 3 3 1, 2, 3, 4, 5 3N 3 1, 2, 3, 4, 5 4 4 2, 3, 4, 5, 6 4N 4 2, 3, 4, 5, 6 5 5 3, 4, 5, 6, 7 5N 5 3, 4, 5, 6, 7 6 6 4, 5, 6, 7, 8 6N 6 4, 5, 6, 7, 8 7 7 5, 6, 7, 8, 9 8 8 6, 7, 8, 9, 10 9 9 7, 8, 9, 10 10 10 8, 9, 10

。

2., for a knee prosthesis system for total knee replacement, comprising:

A. the visibly different femoral component of sizes;

B. the visibly different fixed tibial parts of sizes;

C. the visibly different movable tibial component of sizes;

D. many removable inserts, its respective size and dimension is defined as making it to mate best with one of described femoral component, and can use together with any one in described movable tibial component; And

E. many fixing inserts, its respective size and dimension is defined as making it to mate best with one of described femoral component, and can use together with any one in described fixed tibial parts;

Often kind of size of each prosthese provides with multi-thickness, the parts of knee prosthesis system are listed with following table 1, and list with following table 2 the femoral component size that each femoral component of listing for table 1 provides, thus described knee prosthesis system can be used for the various anatomical structures in PATIENT POPULATION:

table 1: knee prosthesis system parts

table 2: compatible size

。

3. knee prosthesis system according to claim 2, also comprises multiple patellar component, and any one in described multiple patellar component can combinationally use with any one in the visibly different femoral component of described sizes.

4. knee prosthesis system according to claim 2, each in wherein said multiple fixing insert has the thickness of other the fixing insert be different from described multiple fixing insert, and each in described multiple removable inserts has the thickness of other removable inserts be different from described multiple removable inserts.

5. knee prosthesis system according to claim 2, wherein said femoral component comprises multiple CR femoral component, and described multiple removable inserts comprises multiple CR removable inserts, and described multiple fixing insert comprises multiple CR and fixes insert.

6. knee prosthesis system according to claim 2, wherein said femoral component comprises multiple PS femoral component, and described multiple removable inserts comprises multiple PS removable inserts, and described multiple fixing insert comprises multiple PS and fixes insert.

7. knee prosthesis system according to claim 6, wherein said multiple PS fixes each spinous process having upper surface and upwards extend from described upper surface in each and the described multiple PS removable inserts in insert, described spinous process has the rear side comprising depression cam face and actuating cam face, each wherein in sizes visibly different PS femoral component comprises a pair isolated condyle, described condyle limits intercondylar fossa between which and is arranged in the rear cam of described intercondylar fossa, described rear cam comprises depression cam face and actuating cam face, wherein in the first stage of flexing, the described depression cam face of described rear cam contacts the described actuating cam face of described spinous process, in the second stage of flexing, the described actuating cam face of described rear cam contacts the described depression cam face of described spinous process.

8. knee prosthesis system according to claim 7, the size and dimension of the intercondylar fossa of each wherein in the visibly different PS femoral component of size determines the specific anatomical size and dimension coordinating patient femur in proportion.

9. knee prosthesis system according to claim 6, wherein said femoral component comprises multiple CR femoral component and multiple PS femoral component, and described multiple removable inserts comprises multiple CR removable inserts and multiple PS removable inserts, and described multiple fixing insert comprises multiple CR fixes insert and multiple PS fixes insert.

10. knee prosthesis system according to claim 2, each fixing shank that there is fixed platform and distad extend from the bottom of described fixed platform in wherein said size visibly different fixed tibial parts, and the movable shank that each in the visibly different movable tibial component of described size has traverser and distad extends from the bottom of described traverser, and the described fixed and movable shank for specific anatomical size has intimate identical external dimensions and structure, make only to need to carry out intimate identical surgical operation preparation to proximal tibia for each in the described fixed and movable tibial component of described specific anatomical size.